Morphometric Analysis of Adult Acromion Process of Scapula in SouthIndian Population

Background: Morphometric analysis of the acromion process is important in shoulder joint pathologies and the structures passing through the subacromion space or structures present underneath the coracoacromial arch are more prone to undergo impingement and end with impingement syndrome of the shoulder joint. Knowledge on the morphometry of the acromion process is essential before planning surgical treatment of the impingement syndrome such as, acromioplasty or acromionectomy. The present study is aimed to focus on the morphometric analysis of the acromion process. Subjects and Methods: The present study was carried on 100 dry adult scapulae in which 50 were right and 50 were left. The following parameters were measured; length of the acromion, width of the acromion, coracoacromial distance and the acromioglenoidal distance. All the parameters were measured using vernier caliper. Results: The mean length of the acromion process was 42.55mm and 41.43mm on the right and the left sides respectively. The mean width of the acromion process was 23.12mm and 22.8mm on the right and the left sides respectively. The mean coracoacromial distance was 34.16mm and 34.15mm on the right and the left sides respectively. The average acromioglenoid distance was 24.48mm and 24.52mm on the right and the left sides respectively. Conclusion: The morphometric data of this study will be of great importance for the orthopaedic surgeon while treating the impingement syndrome and other surgeries of shoulder joint.

Subacromial Impingement Syndrome of the Shoulder: A Musculoskeletal Disorder or a Medical Myth?

@#Subacromial impingement syndrome (SAIS) is a commonly diagnosed disorder of the shoulder. Though this disorder has been known for a long time, it remains a poorly understood entity. Over the years several hypotheses have been put forward to describe the pathogenesis of SAIS but no clear explanation has been found. Two mechanisms, the extrinsic and intrinsic mechanism, have been described for the impingement syndrome. The intrinsic mechanism theories which deny the existence of impingement are gaining popularity in recent years. The various shoulder tests used to diagnose SAIS have low specificity with an average of about 50%. Meta-analysis shows that neither the Neer sign nor the Hawkins sign has diagnostic utility for impingement syndrome. Several randomised controlled trials have shown that the outcome of treatment of SAIS by surgery is no better than conservative treatment. Physiotherapy alone can provide good outcome which is comparable to that achieved with surgery without the costs and complications associated with surgery. Since decompression with surgery does not provide any additional benefits as compared to conservative treatment for patients with SAIS, the impingement theory has become antiquated and surgical treatment should have no role in the treatment of such patients. There are calls by some practitioners to abandon the term impingement syndrome and rename it as anterolateral shoulder pain syndrome. It appears that SAIS is a medical myth. There are others who called SAIS as a clinical illusion.

The Effect of Acromioplasty in the Suture Bridge Rotator Cuff Repair under Arthroscopy / 中国运动医学杂志

Objective To explore the clinical results of the arthroscopic acromioplasty in the rotator cuff repair.Methods Sixty-five patients (42 males and 23 females) to receive suture bridge repair under the arthroscopy between May 2012 and May 2014 were selected and randomly divided into an experimental group and a control group.The experimental group was given suture bridge repair with acromioplasty,while the control group underwent the suture bridge repair without acromioplasty.The time of operation was recorded.The range of motion (ROM) of the shoulder,the UCLA shoulder scoring system (ULCA) score,American orthopedic surgeon scoring system (ASES) score,the visual analogue scale (VAS) score and Constant score were observed 3 and 12 months after the operation.Results There were no significant differences in age,sex and the affected side between the two groups.Significant differences were found between the two groups in the duration of the operation (t=-18.5,P＜0.05).There were no significant differences in the ROM and the ULCA,ASES,VAS and constant scores of the shoulder 3 and 12 months after the operation.Conclusion No significant differences were found in the ROM and the shoulder function scoring between giving acromioplasty under the arthroscopy or not.However,the operation time of undergoing acromioplasty under the arthroscopy was longer.

Evaluación funcional de la reparación del tendón del supraespinoso comparando técnica mínimamente invasiva contra técnica abierta / Functional evaluation of the supraspinatus tendon repair comparing mini-open and open techniques

Resumen: Objetivo: Comparar dos técnicas quirúrgicas para la resolución del síndrome de hombro doloroso con lesión parcial o total del tendón del supraespinoso (SPS/RTS). Métodos: Pacientes con diagnóstico de lesión completa del tendón del supraespinoso que requirieron reparación quirúrgica y descompresión subacromial. Un grupo fue tratado con acromioplastía y plastía del tendón con técnica abierta (G1) y otro por vía artroscópica más plastía del tendón por abordaje mínimamente invasivo (G2). La asignación de la técnica quirúrgica no fue aleatoria, sino de acuerdo con la preferencia del cirujano. El desenlace principal fue la valoración funcional a 12 meses postquirúrgicos con la escala de UCLA. Comparamos el tiempo quirúrgico, tiempo anestésico, sangrado operatorio y complicaciones inmediatas. Se analizaron promedios y desviaciones estándar para variables cuantitativas y porcentajes para variables cualitativas. Se realizó prueba de U de Mann-Whitney para comparar rangos de grupos no relacionados. Resultados: Fueron tratados en el G1 32 individuos y en el G2 13 sujetos. No hubo diferencias en edad, género, comorbilidades y tiempo de evolución previo al tratamiento quirúrgico. Se encontró mejor función en el grupo G2 de acuerdo con la escala de UCLA (p = 0.032). No hubo diferencias en el tiempo quirúrgico (60 contra 80 min., p = 0.12) ni anestésico (120 contra 97 min., p = 0.12); sangrado total (50 ml ambos, p = 0.09), ni días de hospitalización (dos contra uno, p = 0.81). No hubo complicaciones inmediatas. Conclusiones: La reparación por artroscopía más abordaje mínimamente invasivo para el pinzamiento subacromial y del tendón del supraespinoso parece dar mejores resultados clínicos en la recuperación, funcionalidad y satisfacción de la persona.

Abstract: Objective: To compare two surgical techniques to address the painful shoulder syndrome with partial or total supraspinous tendon tear. Methods: Patients with a diagnosis of complete supraspinous tendon tear who required surgical repair and subacromial decompression. One group was treated with acromioplasty and tendon plasty using an open approach (G1), and the second one underwent arthroscopy with tendon plasty using a minimally-invasive approach (G2). The surgical approach was not decided at random, but was based on the surgeon's preference. The major outcome was functional assessment at postoperative month 12 using the UCLA scale. The variables compared were the operative time, anesthesia time, intraoperative bleeding, and immediate complications. Means and standard deviations were analyzed for the quantitative variables, and percentages for the qualitative variables. The U Mann-Whitney test was used to compare the ranges of non-related groups. Results: Thirty-two patients were included in G1, and 13 in G2. No differences were found in age, gender, comorbid conditions, and the time elapsed before surgical treatment. G2 patients were found to have better function according to the UCLA scale (p = 0.032). No differences were reported in the operative time (60 versus 80 minutes, p = 0.12), anesthesia time (120 versus 97 minutes, p = 0.12), total bleeding (50 ml in both groups, p = 0.09), or length of stay (2 versus 1, p = 0.81). No immediate complications were reported. Conclusions: Arthroscopic repair plus a minimally-invasive approach to treat subacromial impingement and supraspinous tendon tear seems to provide better clinical outcomes based on function recovery and patient satisfaction.

Follow-up Result in Repairing a Type II Superior Labrum Anterior and Posterior (SLAP) Lesion when Associated with Shoulder Impingement Syndrome / 대한정형외과학회잡지

PURPOSE: Type II superior labral anterior posterior (SLAP) lesions can occur in the setting of impingement syndrome. The authors compared the clinical results of patients who had undergone either an isolated acromioplasty or a combined type II SLAP repair and acromioplasty. MATERIALS AND METHODS: Between 2003 and 2008, a total of 75 cases of SLAP II lesions associated with impingement syndrome were recruited. In 39 patients, the type II SLAP lesion was repaired and acromioplasty was performed. In the other 35 patients, acromioplasty was performed alone. All patients were evaluated using the American Shoulder and Elbow Surgeons (ASES) questionnaire and range of motion. RESULTS: At an average of 33 months postoperatively, the ASES scores significantly increased in both groups (p<0.001) but the ASES score was similar in the 2 groups (p=0.278). However, there was a significant difference in the ASES scores when the competitive sports activity of the 2 groups of patients postoperatively were compared (p=0.014). The SLAP repair patients showed limited external rotation motion compared to the acromioplasty alone patients (p=0.026). CONCLUSION: There are no advantages in repairing a type II SLAP lesion when associated with impingement syndrome. However, type II SLAP lesions should be repaired in patients involved with competitive sports activity but the competitive sports activity should be limited for a better result.

Open acromioplasty for acromion impingement syndrome combined with rotator cuff injury / 中华创伤骨科杂志

Objective To evaluate open acromioplasty for treating acromion impingement syndrome combined with rotator cuff injury. Methods From March 2004 to August 2007, 20 cases of acromion impingement syndrome combined with rotator cuff injury were treated in our department. During open acromioplasty, we repaired the rotator cuff, and reconstructed the insertion site with anchor screws for patients who had been diagnosed as complete rupture of superspinatus tendon. Postoperative rehabilitation program was conducted and all patients were followed up at our outpatient clinic. ASES (American Shoulder and Elbow Surgeons) scoring system was used to assess the outcome of the patients. Results Eighteen patients were followed up regularly for an average of 11 (6 to 13)months. The mean ASES score was 90. 5 postoperatively. A significant difference was found between the preoperative and postoperative ASES scores in this group (t= 13.865, P<0.01). Conclusion Open acromioplasty can achieve good outcome in treatment of acromion impingement syndrome combined with rotator cuff injury, and can be carried out by primary hospitals.

Therapy of fracture of proximal humerus with locking proximal humerus plate and anterior acromioplasty / 中国矫形外科杂志

[Objective]To explore the indications and operative techniques for comminuted fracture of proximal humerus. [Method] Twelve patients with fracture of proximal humerus were chosen, observation was made after locking proximal humerus plate fixation with anterior acromioplasty. [Result]The average follow-up period were 12 months (6～24months). All patients' fracture in surgery group had been union and all shoulder had good functions. No incidence of avascular necrosis and nonunion was found. [Conclusion]Rigid fixation of displaced comminuted fractures of proximal humerus with anterior acromioplasty is a simple and effective technique to prevent subacromial impingement syndrome after surgery. Precise osteotomy and early postoperative exercises are the key to success.

Massive Rotator Cuff Tear / 대한정형외과학회잡지

PURPOSE: To report our experience of massive rotator cuff tear and evaluate the final outcome and factors influencing the final results. MATERIALS AND METHODS: We have performed 25 repairs (24 patients) of the massive rotator cuff tear. The average age 58 years old, mean follow-up was 22 months. Acromioplasty alone was performed in 7 cases and acromioplasty with direct repair was performed in 18 cases. We statistically analyzed the results by Student's T-test. RESULTS: Postoperative pain and UCLA score improved 2.2, 32 from 7.4, 14 respectively. The gain of 32 degrees in forward flexion, 8 degrees in external rotation could be obtained. Six (24%) was excellent, sixteen (64%) was good and three (12%) was poor and eigthy-four percent of our series was satisfied. Preoperative range of motion (P=0.040) , the degree of degeneration and the magnitude of tendon retraction (P=0.013) influenced the final results, but age (P=0.232) , duration and severity of pain (P=0.370) did not. There was a significant difference between acromioplasty only and acromioplasty with direct repair even though this discrepancy is very small (P=0.046) . Retear was revealed in 8 cases (44%) among repaired rotator cuff. CONCLUSION: Acromioplasty by itself could get a pain relief and functional improvement and a patient satisfaction in the treatment of massive rotator cuff tear regardless a reparability, but a more favorable result could be expected when a torn rotator cuff was repaired if possible.

Rotator Cuff Repair using Mini - open Technique with Minimized Arthroscopic Acromioplasty / 대한정형외과학회잡지

Treatment of rotator cuff tears by open subacromial decompression has known successful in decreasing pain and restoring function in patients who have failed nonoperative treatment. But, open rotator cuff repair may result in significant deficits in strength and active motion by deltoid separation from the acromion. Deltoid detachment may be avoided by repair using mini-open technique. Arthroscopic subacromial decompression and the rotator cuff repair revel satisfactory results. Subacromial decompression involves decompression of the coracoacromial arch including routine release or resection of the coracoacromial ligament. Recent ligament-cutting studies have confirmed the role of the coracoacromial ligament as a static restraint to superior humeral head displacement. Complete resection of the coracoacromial ligament may be avoided through minimized arthroscopic acromioplasty. We evaluated all 11 patients with rotator cuff tears who underwent arthroscopic minimized subacromial decompression and rotator cuff repairs using mini-open technique. Their average age was 53 years (26 to 64 years); and the average follow-up was 13 months. Preoperatively, all patients complained pain and weakness. Follow-up using modified Hospital for Special Surgery shoulder score showed good to excellent results in 10 cases and poor results in 1 case an average 13 months postoperatively. We found that arthroscopic minimized subacromial decompression and repair using mini-open technique are safe, effective procedure for addressing cuff tears of a wide range of sizes.

Surgical Decompression for the Impingement Syndrome of the Shoulder / 대한정형외과학회잡지

The impingement syndrome has an anatomical character that occur against the anterior edge and the undersurface of anterior third of the acromion, coracoacromial ligament and acromioclavicular joint. The treatment consists of conservative and surgical things. We consider the surgical intervention only in cases fail to control pain by conservative treatment over 3 months(from Feb. 1990 to Jan. 1994). The author experienced 15 cases (14 pts) in positive impingement sign & test and evaluated by shoulder arthrography in all cases. 1. The mean age was 60 years ranged from 48 to 68 years and the average symptom duration was 23 months. 2. There were all positive impingement sign & test clinically. 3. There were partial tear of rotator cuff in 3 cases and complete tear in 12 cases radiologically. 4. The anterior acromioplasty with division of coracoacromial ligament was performed in all cases, additional rotator cuff repair in 3 cases and bicipital tenodesis in 2 cases. 5. At the follow up based on UCLA shoulder rating scale, results were excellent & good in 13(86%) and unsatisfactory in 2(14%) cases.

Arthroscopic subacromial decompression

A study group composed of 11 shoulders in 10 patients underwent arthroscopic subacromial decompression for impingement syndrome. There were no biceps tendon ruptures, acromioclavicular arthritis or glenohumeral instability. Eight men and two women ranging in age from 17 to 65 years (mean age 38.7) with dominant arm involvement in 9/10 were evaluated for an average follow-up of 19.4 months (range 12-26) postoperatively. Based on the University of California at Los Angeles shoulder rating scale, nine (82%) shoulders had satisfactory results and the remaining two (18%) had unsatisfactory results. This is a preliminary report of our early experience in this rather new method of treatment, but the results are encouragingly good.